Provider Demographics
NPI:1265034136
Name:BERMUDEZ, JASMINE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELIZABETH
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16112 W GLENROSA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7767
Mailing Address - Country:US
Mailing Address - Phone:623-332-5683
Mailing Address - Fax:
Practice Address - Street 1:272 E SAGEBRUSH ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4934
Practice Address - Country:US
Practice Address - Phone:623-535-6098
Practice Address - Fax:623-535-1369
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN216409163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty